Mental Health

Background

Regardless of country or region, issues related to mental health are having significant effects on modern society. In 2017, it was estimated that 4.193 million people in Japan were living with mental health issues and their number is expected to continue to increase. Already, the number of people living with mental health issues is greater than the number of people who have been diagnosed with cancer, stroke, acute myocardial infarction, and diabetes combined. In particular, the number of people receiving outpatient treatment is increasing each year and is estimated to have grown to approximately 3.891 million people in 2017. An estimated 302,000 people are hospitalized with mental health-related issues. Although their number is trending downwards, Japan has the most people hospitalized in psychiatric wards on a per capita basis in the world. According to the 2018 Hospital Report from the Ministry of Health, Labour and Welfare (MHLW), the average length of stay for psychiatric care beds was significantly longer than for general care beds, at 265.8 days and 16.1 days respectively. That report also found significant regional disparities in average lengths of stay. Various factors can cause poor mental health or mental illness. In addition to social and economic stress factors, they include the conditions encountered after natural disasters like the Great Hanshin-Awaji Earthquake or the Great East Japan Earthquake as well as changes in the employment or household environment caused by a worsening economy. For these reasons, issues related to mental health must be approached as issues that affect society as a whole, without responses being limited to the field of healthcare.

The World Health Organization (WHO) recently enacted its Comprehensive Mental Health Action Plan 2013-2020. Meanwhile, efforts are advancing to promote the spread of best practices and information through international cooperative initiatives and comparative studies. In Japan, the enactment of the Act for Mental Health and Welfare in 1995 or the issuance of the Vision for Reform of Mental Health and Medical Welfare in 2004 have led to cooperative efforts between healthcare and welfare aimed at building support systems for people with mental disorders and their families. In addition, mental health was included as a targeted field in the sixth revision of the Medical Care Plan System, which came into effect in 2013. Meanwhile, the seventh revision of the Medical Care Plan System and the fifth revision of the Disability Welfare Plan both mentioned building an Integrated Community Care System for Mental Disorders. To empower people who have developed mental disorders to live as full members of their communities with peace of mind and pride, these developments aim to create an integrated care system that provides healthcare, welfare for people with disabilities, long-term care, housing, social participation (i.e., employment), networks for mutual support in communities, and education. Achieving these goals will require broad cooperation between multi-stakeholders.

Compared to the international situation, however, there are many domains of policy in Japan for which efforts must be intensified in the future. These include promoting knowledge and understanding towards each mental illness among the public, establishing care practices that are based on the needs of people with mental disorders, involving those most affected in the development and provision of services, creating support systems which unite the public and various professions while advancing the establishment of the Integrated Community Care System for Mental Disorders, and building systems with the capacity to provide mental health care over the life course. Rapid reforms based on international trends are also necessary. At the same time, policies that provide effective guidance are needed to make a smooth transition from existing healthcare provision systems. For example, existing stakeholders should be provided with incentives in the event of reform. Other necessary efforts that will contribute to improving quality of life (QOL) for people with mental disorders include examining the best way to structure the hospitalization system, providing diverse high-quality inpatient care, strengthening the mental health and medical welfare systems so people who are hospitalized can transition back to community living, and creating more treatment options by introducing new non-pharmacological therapies in addition to traditional pharmacotherapy. All of this will require the creation of an environment in which regional disparities in access to care have been eliminated and everyone has equal access to care.

Mental Health Policy Project Overview

Review of FY2019 Activities

HGPI began activities for the “Global Trends and Japan’s Mental Health Policy” Project in FY2019 by gathering an advisory board that brought people living with mental disorders and others most affected together with opinion leaders and related organizations in the field from industry, government, academia, and civil society from both Japan and abroad. There, we held repeated discussions that crystallized current issues and discussion points in Japan’s mental health policy and examined approaches to solving them.

We then held an advisory board-centered global expert meeting to provide an opportunity for experts in the field from Japan and overseas to voice their opinions on the issues and discussion points identified by the advisory board as well as on the advisory board’s preferred solutions. We published reports on that meeting to communicate the necessity of promoting mental health policy to stakeholders in Japan and abroad. The global expert meeting was hosted together with the Department of Frontier & International Psychiatry of the Graduate School of Medicine of Kyoto University with participation from the Johns Hopkins University Department of Psychiatry and Behavioral Sciences in the United States. It was held in two sessions entitled “Leading Experts’ Talk on the Global Trends in Mental Health” and “Multi-stakeholder Discussion on Japan’s Mental Health Policy – The Way Forward.” It was an opportunity for active opinion exchanges and discussions between various stakeholders, particularly the panel discussion. Key points that were raised are summarized below.

Future measures for mental health policy identified at the FY2019 Global Expert Meeting

Promote a life course approach and multi-stakeholder discussion.
Unite all related professions and local organizations to achieve mental health care for the entire life course.
After gathering the experiences of those most affected and healthcare providers and promoting cooperation between those parties, formulate policy proposals from the perspectives of those most affected.

Review of FY2020 Activities

Presentation of the “Mental Health 2020 – Proposal for Tomorrow” policy proposal and advocacy activities

Based on our activities in FY2019, the Mental Health Policy Project Team presented its policy vision “Mental Health 2020 – Proposal for Tomorrow” in July 2020. In addition to knowledge gained over efforts for this project in FY2019, it describes issues and next steps identified through hearings with broad stakeholders from industry, government, academia, and civil society and a desk study of best practices from Japan and abroad. The proposal is based upon the following five perspectives.

Perspective 1. Expand policies that raise mental health literacy in society and promote the activities of those most affected.

Perspective 2. Establish systems for providing care that are integrated into communities, compatible with everyday life, and meet the needs of people with mental disorders.

Perspective 3. Build an infrastructure for community living that provides places to live, places to work, and places to belong.

Perspective 4. Build the data and information gathering systems needed to make evidence-based policy-making and policy evaluation possible.

Perspective 5. Establish an environment that allows for multi-stakeholders to engage in continuous discussions on mental health policy.

(For details, please visit https://hgpi.org/en/research/mh2020pp.html.)

After publishing the proposal, we worked to disseminate it within the government and among members of the public in pursuit of the vision of realizing citizen-based healthcare policy. In addition to policy makers such as members of the national Government, members of municipal governments, Diet members, and local government assembly members, we exchanged opinions on the proposal with people with mental disorders, their families and caregivers, and civil society. We have also been engaged in various other activities including publicity and outreach to relevant stakeholders and the media, lobbying the Government through Diet member briefings, and publishing our recommendations online to stimulate public discussion. Policy makers have selected certain recommendations for consideration and efforts to examine their real-world implementation are now underway.

The “Mental Health Policy in the Eyes of Those It Affects” Interview Series

One of the aims of this project is to utilize our experiences collaborating with patient organizations in various disease fields to build a platform for mutual respect and effective collaboration among organizations in the field of mental health. To begin that process, we conduct a series of interviews with project collaborators to hear their candid opinions on the policy vision described above. We also interviewed people with mental disorders and supporters of people with mental disorders. During those interviews, they gave honest evaluations of our policy vision and shared their expectations for the future of mental health policy.

Interview 1: “Elucidate the physiology of recovery by improving longitudinal studies,” Mr. Ken Udagawa (COmmunity Mental Health & welfare Bonding Organization Chairperson)

Interview 2: “Placing Mental Health at the Center of National Policy for Harmony between the Healthcare System and Communities,” Mr. Yasuhiro Obata (Secretary General, The National Federation of Associations of Families with The Mental Illness in Japan (Minna-net))

Interview 3: “As Someone with a Mental Disorder, I Want to Help People Facing Similar Circumstances,” Mr. Kenjiro Horiai (YPS Yokohama Peer Staff Association)

Interview 4: “Gather and share examples of role models and establish a safety net so people with mental disorders can live every day with peace of mind,” Mr. Keigo Kobayashi

Interview 5: “Enact citizen-driven policies so people with disabilities are supported by society as a whole,” Professor Natsuko Hagiwara (Chairperson, Japan NPO Center (JNPOC); Professor, Graduate School of Social Design Studies, Rikkyo University)

“Online Survey for Reviewing Mental Health 2020 – Proposal for Tomorrow and Identifying Policy Issues in the Field of Mental Health” Report

At the global expert meeting held in FY2019 and in the policy vision presented in FY2020, we were able to raise issues in mental health policy as perceived by a wide variety of stakeholders. However, a great diversity of people is involved in this field, so we conducted an online survey to identify policy issues and to gather as many ideas as possible.

Based on the recommendations presented by Mental Health 2020 – Proposal for Tomorrow, this survey emphasized perspectives on the life course and the treatment process (prevention, treatment, and prognosis), which are of universal importance to people with mental disorders. Our goals were to identify hurdles to providing support that is closer to the daily lifestyles of individuals affected by mental disorders in every stage of life and to discover areas where more support is needed. By incorporating these perspectives into our study, we aimed to pinpoint which types of support are interrupted during the life course and to highlight issues that must be addressed over life stage transitions to establish a comprehensive policy agenda for providing long-term support on an individual basis.

While this survey reaffirmed the importance of a policy response for certain issues raised in our proposal, it also identified several new issues. For example, “Improve self-affirmation, resilience, and education on self-care,” “Promote psychosocial intervention research,” and “Secure opportunities for discussions involving diverse stakeholders on promoting measures in each region” were newly identified through the survey and were ranked as the most important issues in their respective fields.

Establishing Working Groups and Advancing Discussions

After arranging issues identified in the course of the mental health project in December 2020, we decided to establish separate working groups that will discuss each key policy issue in detail. In FY2021, the working groups described below will explore their respective themes, formulate and present policy proposals, and advocate for reform.

The Working Group on Cognitive Behavioral Therapy (Will meet from November, 2020 to March, 2021; conducted as part of the FY2020 Ministry of Health, Labour and Welfare Project for the Promotion of Comprehensive Welfare for Persons with Disabilities)
The Working Group on Disaster Mental Health (Will meet from February 2021)
The Working Group on Education and Literacy (Will meet from April 2021)
Planning and arrangement of other working groups is currently underway.

The Working Group on Cognitive Behavioral Therapy was established in response to high expectations for non-pharmacological therapies, especially CBT. Such expectations were expressed during the formulation of Mental Health 2020 – Proposal for Tomorrow. It will examine the future of CBT while incorporating knowledge from dissemination and implementation science to promote the use of CBT and will issue its recommendations on the ideal future structure of CBT in Japan in March 2021.

The Working Group on Disaster Mental Health will look back on the ten years that have passed since the Great East Japan Earthquake, examine post efforts made in disaster mental health, and explore methods for building sustainable systems needed during normal times, immediately after disasters, and during recovery and reconstruction.

The Working Group on Education and Literacy will examine themes related to education and literacy. Such themes were outlined in Perspective 1 of Mental Health 2020 – Proposal for Tomorrow and were identified as issues of particularly high priority that require further consideration in the online survey described above. To examine mental health issues among children and adolescents, the working group will also collaborate with HGPI’s project for child health.

Last Modified: April 2021